Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot.

Defective wounds in diabetic foot are difficult to manage. Several studies reported the use of reverse sural flap in a small number of patients with varying success. We presented our experience with the reverse sural island flap (RSIF) in a series of 37 patients associated with diabetic foot using the delay procedure. The ages of the patients ranged between 36 and 73 years. We did not perform angiographic evaluation to determine the existence of vascular connections between the branches of the peroneal and posterior tibial artery; however, Doppler ultrasound evaluation was done to determine the patency of anterior and posterior tibial arteries, as well as lesser saphenous vein before the operation. The flaps were transferred using a 3-step delay procedure. While all the first and second steps of the operations were done under local anesthesia, the third steps were performed using general anesthesia in 12 and spinal anesthesia in 25 patients. All flaps survived except 4 showing partial necrosis due to venous insufficiency. Delaying the RSIF is a reliable procedure for diabetic foot skin defects.